Pulmonary Flashcards
Regulation of respiration involves what?
- Control of the respiratory center
- Balance maintained between para and sympathetic nervous systems
Control of the respiratory involves:
- Medullary rhymicity center
- Vagul Input from lungs
- _____
ABGs- arterial blood gases
The PNS mainly produces ___________ and mucus __________
The SNS mainly involves B2 receptors _________ smooth muscle and _________ mucociliary clearance
- bronchoconstriction, secretion
- relaxing, increasing
What does clenbuterol do?
Helps build muscle, can cause cardiac issues
Our respiratory tract is divided into _____ and ______
Upper and lower
What is the function of our upper respiratory tract?
- consists of our nasal and oral cavity, larynx, pharynx, and trachea
- warms, humidifies, and filters inspired air (1st line of pulm immune defense)
- mucocilliary escalator-lines conduction airways for 2nd line of defense
What does the lower respiratory tract consist of?
- trachea, bronchi, bronchioles, and alveoli
- immune cells complete pulmonary defense
Function of the trachea and bronchial tree?
Warm/moisten air
Function of the alveoli?
Primary gas exchange site
What does V stand for?
What does Q stand for?
Together they make what?
- V=ventilation
- Q=perfusion
- V/Q ratio:
- amount of air breathing in/amount of blood to lungs
What is dead space?
What is shunt?
Dead space
- When ventilation is in excess of perfusion
- The alveoli are ventilated but not perfused
Shunt
- When perfusion is in excess of ventilation
- The alveoli is perfused but not ventilated
What is considered regular breathing in terms of volumes?
Tidal volume
What are the categories of drugs used to treat respiratory tract irritation and control respiratory secretions?
- Decongestants
- Antitussives
- Antihistamines
- Mucolytics and Expectorants
Deongestants MOA?
AE?
- MOA (usually alpha-1 adrenergic agonists)
- cause vasoconstriction
- reduce blood flow and hence outflow from capillaries
- HA, dizziness, nerevousness, nausea, CV irregularities
- *can mimic the effects of increased sympathetic NS activity
Who shouldn’t take decongestants?
What drugs does this counteract?
- People with high BP, can raise BP
- beta-blockers
Antitussives MOA?
AE?
- MOA-decrease afferent nerve activity or decrease cough center sensitivity
- sedation, dizziness, GI upset
Antitussives are usually recommended for ______
short-term use
Antitussives are used to suppress a __________ as opposed to a ____________
- dry cough
- productive cough
Benadryl is an example of a _________
antihistamine
Antihistamines are used to manage respiratory _________ responses
allergic
Antihistamines block histamine receptors reducing what?
- Mucosal irritation
- Decreases sneezing caused by histamine associated sensory neural stimulation
- Decreased nasal congestion
What are the primary AE of antihistamines?
- Sedation
- Fatigue
- Dizziness
- Blurred vision and incoordination
Whats the difference between 1st gen and 2nd gen antihistamines?
1st gen cross the BBB while 2nd gen do not easily cross
Is there a higher risk of side effects with 2nd gen antihistamines?
No, but they are not devoid of side effects
- Side effects can include same as 1st gen plus:
- dry mouth
- sore throat
- cough
- nausea
- HA
Can antihistamines be used on people with asthma?
Yes, will not dry up the airways and aggravate asthma
Mucolytics MOA?
-split disulfide bonds
Mucolytics are drugs which _______ the viscosity of respiratory secretions (mucus)
decrease
-in doing so they loosen and clear mucus from the airways
Expectorants act to facilitate the __________ and ___________ of mucus.
How does it do this?
-production and ejection
- causes a thinning of mucus
- promotes a productive cough
- lubricates respiratory tract
-Expectorants are used to treat both _____ and ______ conditions ranging from common colds to emphysema
acute and chronic
Decongestants can ______ effects of the SNS.
increase
-vasoconstriction can increase BP
Who should avoid OTC decongestant products?
HTN patients
What is emphysema?
A accumulation of air in the tissues, particularly in the lungs
What is emphysema commonly associated with?
Smoking
Lungs with emphysema don’t ______ and _______ as well as a regular lung.
stretch and recoil
People with emphysema have a decrease in _____ volume but an increase in ______ volume.
- tidal
- residual
What are the clinical manifestations of emphysema?
- Exertional dyspnea progresses to dyspnea at rest
- Tachypnea (increases RR)
- Use of accessory breathing muscles for ventilation
- Barrel Chest
What classifies someone as having chronic bronchitis?
Someone who has a really productive cough, lasting for at least 3 months per year for 2 consecutive years
What are the clinical manifestations of chronic bronchitis?
- Persistent cough and sputum production
- Shortness of breath
- Prolonged expiration
-Late effects including pulmonary hypertension leading to cor pulmonale, severe disability and death
What is cor pulmonale?
Right sided heart failure caused by increase in pulmonary artery BP
S28 Changes in Chronic Bronchitis and Emphysema
S28
Goals of treatment for COPD
- reduce airway edema secondary to inflammation and bronchospasm through the use of BRONCHODILATOR medication
- elimination of bronchial secretion
- prevent and treat respiratory infection
Inhaled beta agonists:
- If acting in the lungs, B1 or B2 receptor?
- What type of receptor is this?
- What neurotransmitter typically binds this type of receptor?
- Is this sympathetic or parasympathetic activity?
- B2
- Adrenergic
- Epi and NE
- Sympathetic
Inhaled beta agonists are divided into ____ and ____.
- SABA (short acting)
- LABA (long acting)
What do inhaled beta agonists usually end in?
-end in -terol
What is the MOA for both SABA and LABA?
-agonize B2 receptors= bronchodilation
SABA onset?
Duration?
Use?
- onset- 5 minutes
- duration- 4-6 hours
- use as needed for SOB (shortness of breath)
LABA Duration?
Dosage?
- duration- 12-24 hours
- once or twice daily
SABA is generally used for _____ reasons while LABA is typically taken on an _______ basis
- acute
- ongoing
What are the AE of Inhaled beta agonists?
- generally well tolerated
- can cause tachycardia, tremor, hypokalemia
Inhaled antimuscarinics (anticholinergic) are divided into ____ and ____.
- SAMA (short acting muscarinic antagonist)
- LAMA (long acting muscarinic antagonist)
What is the MOA for both SAMA and LAMA?
-primarily binds M3 in airway smooth muscle; antagonizes ACh actions at these sites = bronchodilation
SAMA Onset?
Duration?
- 15-20 minutes
- 6-8 hours
LAMA Duration?
Dosage?
- 12-24 hours
- once or twice daily
What are the most common AE of SAMA and LAMAs?
generally well tolerated but can cause dry mouth
What are inhaled corticosteroids typically used for?
In COPD they are typically used for exacerbations or more severe diseases
What do inhaled corticosteroids typically end in?
-end in -asone
What are some of the many AE of inhaled corticosteroids?
- oral candidiasis (prevent by rinsing mouth)
- hoarse voice
- skin bruising
- increased risk pneumonia
What is the benefit of using combination of products with treatment?
Combining bronchodilators may increase effect with lower AE as compared to increasing dose of a single product
- SABA and SAMA
- LABA and LAMA
- LABA and ICS
- LABA and LAMA and ICS
What are the goals of COPD treatment?
- decrease symptoms
- increase exercise tolerance
- improve health status
- prevent disease progression
Can someone be on one class of drug and still have advanced COPD?
Yes
What can be the causes of inhalers not working?
- Disease progression
- Incorrect inhaler or nebulizer use
- Nonadherance(need edu on PRN vs maintanence meds)
- In COPD, may not be able to produce force necessary
Phosphodiesterase-4 (PDE-4) Inhibitor MOA?
AE?
-MOA- decrease breakdown of intracellular cyclic AMP = decrease in inflammation
- AE-present in 5% or less of patients
- diarrhea (10%)
- nausea (5%)
- weight loss (up to 20%)
PDE-4 is generally used for what?
more severe COPD
When are antibiotics used for COPD? What class ends in -mycin?
used in acute exacerbations
- extended treatment only in patients prone to exacerbations
-macrolide
What is bronchial asthma?
-A reversible obstructive lung disease characterized by infammation and increased smooth muscle reaction of the airways to various stimula
Is bronchial asthma chronic or acute?
Both
-Its a chronic condition with acute exacerbations
Unlike chronic bronchitis and emphysema it can affect what?
All ages
-Most common chronic disease in adults and children
What is the difference between extrinsic asthma and intrinsic asthma?
Extrinsic:
-caused by allergic exposure
Intrinsic:
- non-allergenic
- no known trigger
What is EIA?
Exercise induced asthma
-especially in cold, dry air that may cause bronchoconstriction
Clinical manifestation of asthma?
- S/Sx differ in presentation, degree, and frequency
- Sensation of chest constriction
- Inspiratory and expiratory wheezing
- Nonproductive cough
- Prolonged expiration
- Tachypnea and cardia
What is status asthmaticus?
An acute attack that cannot be altered with routine care; medical emergency; can be fatal
Asthma treatment goals?
- decrease impairement
- decrease risk
What is the maintenance of treatment?
1st line- ICS and LABAs
What is the difference between asthma and other COPD disorders in regards to medication?
Inhaled corticosteroids are added into treatment earlier than any other. (2nd step) S49
ICS and LABA
ICS used as maintanence to decrease ________ and risk of __________.
PO is only taken when?
Why is LABA used in combo with ICS?
Do NOT use for _______ symptoms, _________ or long term monotherapy.
- impairement and risk of exacerbation
- PO only taken for acute exacerbation or severe persistent asthma
- Used with ICS to maintain lower ICS dose to prevent ICS AE
- acute symptoms, exacerbations
Leukotriene modifiers are split into ______ and __________.
- LTRA (leukotriene receptor antagonist)
- 5-lipoxygenase inhibitor
Leukotrienes receptor antagonist (LTRA) MOA?
What do they do?
- MOA- competitively antagonize leukotriene receptors
- released from mast cells and eosinophils to play a role in airway edema, smooth muscle contraction, inflammatory process
Leukotriene receptor antagonist (Montelukast) for asthma are taken _____ daily (for allergies can only be used in the __).
They are alternative agents for ____ and ________
- once
- AM
-kids and adults
5-lipoxygenase inhibitor MOA?
AE?
- selectively inhibits 5-lipoxygenase, a key enzyme in the conversion of arachnoid acid to leukotrienes
- rare hepatotoxicity
5-lipoxygenase inhibitor are only an alternative for ______.
adults
Immunomodulators: Anti IgE MOA?
AE?
- MOA- binds IgE antibody→ prevents IgE binding to receptors on mast cells and basophils→ limits activation and release of allergic response mediators
- AE- headache, injection site reaction
Are Anti IgE becoming more commonly used?
Yes
Immunomodulators: Interleukin Antagonists MOA?
AE?
- MOA- monoclonal antibodies that binds interleukins→ results in decrease inflammatory responses; inhibiting IL-5 specifically decreases eosinophils which are specifically associated with asthma pathogenesis
- AE- injection site reaction, headache, increased creatine kinase
Cromolyn Sodium MOA?
AE?
- MOA- prevents mast cell release of histamine, leukotrienes, and slow reacting substance of anaphylaxis by inhibiting degranulation after contact with antigens
- AE-transient cough, wheezing
Is cromolyn sodium commonly used?
No
Methylxanthines MOA?
AE?
- MOA-inhibits phosphodiesterase= bronchodilation
- AE- insomnia, gastric upset, tremor, increased hyperactivity in some children
Methylxanthines are only used as _______ maintenance treatment, not as effective or commonly used
adjunct
-has a NTI
Acute symptom relief and exacerbation.
SABA
-for acute symptom relief or exercise-induced bronchoconstriction (EIB)
SAMA
-may be used in combo with SABA in emergency care setting
PO steroids
-moderate-severe exacerbations
What is used in pediatrics to ensure med delivery?
Spacers
Elite athletes with asthma often time requires this to use their medication.
Therapeutic Use Exemption
What does WADA stand for?
World Anti Doping Agency
What is cystic fibrosis?
-Cystic fibrosis affects the cells that produce mucus, sweat, and digestive juices. It causes these fluids to become thick and sticky. They then plug up tubes, ducts, and passageways.
What drugs are used for maintanence of cystic fibrosis?
-LABA
- SABA used prior to:
- chest physiotherapy
- other inhaled meds that may produce bronchospasm
- exercise
What do CFTR modulators do?
Regulate sodium and water which helps keep mucous thin
What are the main drugs and their functions?
- Ivacaftor- improves CFTR activity by keeping chloride channels open longer
- tezacaftor/lumacaftor- facilitate trafficking of CFTR to cell membrane surface
What is the overall function of the CFTR modulators?
Sodium and water regulation for mucous thinning
Do CFTR modulators interact with CYP enzymes?
CFTR Modulators must be taken with what?
- Yes, DDI interactions
- High fat meals to increase absorption
What are the AE of CFTR Modulators?
- HA
- GI
- Respiratory
Less common:
- dizziness
- HTN
How do Mucolytics help to treat Cystic Fibrosis?
- decrease risk of exacerbation
- increase lung function and QOL
What are the 2 main Mucolytic drugs used for Cystic Fibrosis?
- hypertonic saline
- dornase alfa
How does hypertonic saline work?
-increase salt in airways to draw more water into airways
How does dornase alfa work to treat cystic fibrosis?
-cleaves DNA which decreases mucous viscocity
What are the AE of dornase alfa?
- chest pain
- cough
- voice disorder
- skin rash
Can anti-inflammatory be used to treat Cystic Fibrosis?
Yes
When can ibuprofen be used for treatment?
- If <18 yo, can take high dose. Not beneficial in adults.
- Not common due to required monitoring.
Can we use inhaled antibiotics for treatment of Cystic Fibrosis?
How?
Yes
-Benefit > Risk because P. aeruginosa increases morbidity and mortality
What is different about the treatment of inhaledantibiotics?
-Nebulized 2 or 3 times daily for 28 days, then 28 days off
What is the nutritional support aspect of treatment of Cystic Fibrosis?
- Supplement vitamins A,D,E,K
- Pancreatic enzyme replacement therapy (PERT)
What are the additional complications related to Cystic Fibrosis?
- Cystic Fibrosis related Diabetes (CFRD)
- Bone Disease
- Liver Disease
- Lung Transplant
Overall therapeutic concerns with drugs for respiratory conditions.
Anticholinergic drug
- Tachycardia
- HTN
- Dry Mouth
Steroids
- Inhaled drugs: oral candidiasis
- Infection risk
- HTN
- Hyperglycemia
- Osteoporosis
- Muscle Weakness
B2 agonists
- Tremor
- Tachycardia
- Hypokalemia
- Hyperglycemia
